Provider Demographics
NPI:1750801585
Name:RODRIGUEZ, JACQUELINE MARGUERITE (DMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MARGUERITE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 W THOMAS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-3989
Mailing Address - Country:US
Mailing Address - Phone:847-738-7659
Mailing Address - Fax:847-738-7659
Practice Address - Street 1:8 S MICHIGAN AVE STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3475
Practice Address - Country:US
Practice Address - Phone:312-283-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190311001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice